Lasik: A Handbook for Optometrists

Lasik: A Handbook for Optometrists is a useful guide for optometrists involved in refractive surgery shared care and also those who are not directly involved but handle questions regarding the procedure on a regular basis - pretty well all optometrists.
It is very much an easy reference clinical guide for the practising optometrist, looking at the procedure from an optometric rather than ophthalmological viewpoint. Those looking for a textbook detailing history and technical information regarding equipment in particular will be disappointed. Like it or not, refractive surgery is here to stay and all optometrists should be prepared to deal with queries and give informed advice to their patients.
Chapter 1 gives an overview of the regulations and guidelines surrounding refractive surgery, and highlights the redundancy of many of the existing guidelines. With changes relating to optometrists and therapeutics an 'in vogue' topic, management of postoperative patients may become more interesting in the near future. A useful inclusion in this chapter is occupational regulations, which enables the practitioner to discuss future career implications with patients interested in refractive surgery.
Chapter 2 is particularly useful for optometrists in practice dealing with Lasik enquiries. It details routes of referral, and information required by the clinics. Perhaps most useful is the criteria to consider before referral, and a list of contra-indications, enabling the optometrist to discourage patients where treatment is a definite negative and to manage patient expectation. Although this is briefly mentioned in a later chapter, there is not much emphasis placed on consideration of ocular motor balance, and potential postoperative binocular status, at this pre-referral stage.
Chapters 3 to 5 deal with preoperative assessment. Again there is some overlap with the battery of tests completed by all optometrists and this section is a useful reference because patients with certain results can be managed before reaching the clinic. An example would include the section on keratometry, where it is noted that patients with 'k' readings below 41.00DS and greater than 46.00DS are at risk of microkeratome complications. The concern, however, is that this may lead to optometrists crossing the boundary of surgical decision-making, preferably reserved for trained practitioners within a clinic.
The sections on topography and pupil assessment are valuable, as many patients will attend for a consultation and then inundate their usual optometrist with a barrage of questions, including results provided from the clinic, before making their decision.
The brief examination of alternative techniques is also useful, though somewhat cursory. It may be beyond the remit of this book, but some practitioners may favour more detailed information in order to feel that they have properly helped their patients make the right decision. It should be noted that the final chapter does cover Lasek in more detail. For a reader working within a refractive clinic it might have been beneficial to extend the section on wavefront aberrometry, but to an optometrist practising elsewhere it is a useful synopsis to aid patient discussion.
Chapter 6 considers the treatment itself. It is a perfunctory account of the procedure, but does include some anecdotal accounts. Readers expecting technical specifications will need to search elsewhere. After all, this book is written for optometrists not surgeons, and more detailed discussions relating to nomograms, adjustment factors, and assembly of the microkeratomes for example are all topics that should be available in surgical manuals. The only notable absence was a section on the position of the flap, as some optometrists may have to deal with queries regarding this.
Perhaps the most interesting areas to the average clinician are finally covered in Chapters 7, 8 and 9. Apart from the actual surgical procedure itself, most of the preoperative assessment includes procedures and clinical observations already familiar to the practising optometrist. These three chapters look at postoperative assessment, complications and subsequent care. A section on re-treatments is also incorporated.
Included are very useful descriptions and colour pictures of the most common postoperative complications and the necessary management. The reader is able to learn what is normal and therefore acceptable and what needs ophthalmological opinion or treatment. Notable inclusions are diffuse lamellar keratitis (DLK) and a listing of flap complications rarely seen outside of Lasik.
The unfortunate trend of some patients seeking treatment abroad and then returning to their regular practitioner for aftercare makes these chapters an indispensable aid to the inexperienced clinician.
It was amusing to note at the beginning of Chapter 8 a reference to confirming patient medical history; an example was given of a female patient who had become pregnant since treatment. However, an earlier chapter had included pregnancy as a contra-indication as the healing response might be altered. Perhaps dissuading female patients from becoming pregnant should be part of pre-counselling!
The final chapter is a useful overview on Lasek. The book does lack detail with respect to other refractive options, as mentioned earlier, but Lasek is a prudent inclusion as many clinics will offer both Lasik and Lasek as alternatives.
Many of the textbooks currently available relating to Lasik are written by ophthalmologists for ophthalmologists, and contain excessive information beyond the interest of an optometrist needing a quick reference manual. Optometrists not wanting to wade through a more detailed textbook will find this book a useful primer for their consulting room.

Lasik: A Handbook for Optometrists by Michelle Hanratty was published by Butterworth Heinemann Health last month. ISBN 0750688092, Paperback 172 Pages 99 Illustrations, 34.99. Visit www.optometryonline.net for a 10 per cent discount.

Joy Myint is an optometrist practising in central London